Long-term dependence on total parenteral nutrition can result in significant risks to a patient. Complications such as end-stage liver disease, vein clotting or loss of central venous access due to the use of catheters to administer TPN are indications that your patient may be a candidate for an intestinal transplant.

Nebraska Medicine has one of the oldest and largest intestinal transplant programs in the country for both adults and pediatrics and is often a patient's last stop.

The transplant program is also one of a few in the country that is tied very closely to an intestinal rehabilitation program, a difference that has a significant impact on a patient's care and treatment.

"Restoring enteral autonomy to these patients whenever possible is the preferred medical practice and can greatly improve quality of life," says David Mercer, MD, PhD, intestinal transplant surgeon and director of the Intestinal Rehabilitation Program. The program treats patients with symptoms ranging from chronic abdominal pain and malnourishment to complete loss of the small intestine. Treatment for each patient is strictly individualized using advanced medical and surgical techniques to restore gastrointestinal function and encourage intestinal adaptation.

"When patients come here, we start with a comprehensive intestinal failure evaluation," says Dr. Mercer. "In the majority of cases, we find that we can treat their condition and delay or eliminate the need for a transplant by engaging the patient in intestinal rehabilitation as opposed to an intestinal transplant."

Broadly defined, intestinal failure (IF) is the inability to maintain a reasonable state of nutrition and hydration using the gut alone. In children, this is often the result of a problem at birth such as gastroschisis, necrotizing enterocolitis or intestinal atresia. In adults, IF can develop suddenly from problems such as intestinal volvulus or ischemia or more insidiously after multiple operations for inflammatory bowel disease or adhesive obstructions.

Patients who become candidates for a transplant typically have relatively short waiting times, ranging from weeks to a few months. "For intestinal transplants, there are more organs available than patients on the waiting list," says Dr. Mercer. Following the transplant, the patient will need to stay in Omaha for one to two months to allow for close monitoring and management of their recovery. The medical center offers lodging facilities on campus for patients and families to stay during this period.

Five-year survival for adult intestinal transplants is 70 percent, says Dr. Mercer. After about a year, most have reduced their medications to about one or two immunosuppression medications. "Most patients do very well and go on to have fairly good function," says Dr. Mercer. "Our expectation is that they will have that transplant for the rest of their life."

The Intestinal Transplant Program takes on some of the most complex cases. "We are prepared to tackle operations that most other transplant surgeons won't touch," says Dr. Mercer. "This comes from years of refining the procedure and eliminating sources of error. When you keep perfecting a surgical technique, your degree of technical complexity and ability to expand on who you can perform surgeries on increases. There's rarely a case that we will turn down unless we feel it won't benefit the patient."